Inpatient mental health care services

Please adhere to the following when treating members in mental health inpatient or residential settings:

• All services must be preauthorized by the Mental Health Access Center (MHAC) at 206-901-6300 or 1-888-287-2680.
• Authorizations are not provided after-hours, on holidays, or on weekends. In these cases, contact EPRO (Emergency Patient Resources and Options) at 1-800-337-3197 to inform Kaiser Permanente of admission. The MHAC will review on the next business day.
• Throughout the member's stay, we will review their care for appropriateness of placement and participate in discharge planning.
• To arrange follow-up care, contact the MHAC prior to discharge. Follow-up care must be provided within seven days of the discharge date.

If a member needs to transfer from a mental health facility to a medical or surgical facility, notify Kaiser Permanente via EPRO at 1-800-337-3197 and the member's primary care provider.

We reserve the right, upon consultation with a Kaiser Permanente physician, to transfer any member to a Kaiser Permanente facility, as stated in the member's medical coverage agreement. If the member refuses to transfer to one of our facilities, costs incurred during the hospitalization may be the member's sole responsibility.

Kaiser Permanente requires prior authorization of inpatient mental health care for all members, including members using their out-of-network benefits and members who do not want their care managed by Kaiser Permanente. Prior authorization assures Kaiser Permanente that the services are medically necessary and appropriate, that the provider and/or facility is fully licensed and capable of providing the highest level of care and allows Kaiser Permanente to plan for adequate follow-up care.

Prior authorization is not required for admission for emergency care. However, the care must meet medical necessity criteria. If a member is admitted to inpatient treatment as a direct result of an emergency room visit, the member or a family member must call the Kaiser Permanente Emergency Notification Line within 24 hours following the emergency or as soon as medically possible. You can obtain authorization after the health plan reviews clinical information, normally provided by the treating provider.

Kaiser Permanente complies with WA E2SHB 1688 (“Protecting consumers from charges for out-of-network health care services, by aligning state law and the federal no surprises act and addressing coverage of treatment for emergency conditions”) related to coverage of emergency services and alignment of state and federal balance billing laws. This Washington state law requires health plans to cover emergency behavioral health services provided by any in-network or out-of-network emergency behavioral health services provider, without any prior authorization requirement.

Per ESHB 2642, the following guidelines apply to acute inpatient and residential treatment for addiction and recovery:

• Regarding acute withdrawal management, members are eligible for 3 covered days of treatment without prior authorization. After the initial 3 covered days, ongoing care is subject to medical necessity criteria. If a member is admitted to acute withdrawal management, the member or a family member must call the Kaiser Permanente Emergency Notification Line within 24 hours following the admission or as soon as medically possible. For subacute withdrawal treatment you should obtain prior authorization.
• Regarding residential substance use disorder treatment, members are eligible for 2 covered days of treatment without prior authorization. After the initial 2 covered days, ongoing care is subject to medical necessity criteria. If a member is admitted, the member or a family member must call the Kaiser Permanente Emergency Notification Line within 24 hours following the admission or as soon as medically possible. While members with an out-of-network benefit may choose from which facility to receive service, their planned inpatient stay must be authorized prior to admission.
• We will continue to cover only medically necessary residential treatment for substance use disorders for people with comprehensive benefits for substance abuse services, following prior authorization.
• While we do not require prior authorization for PPO health plan members, we do require proof of medical necessity. A provider or member may request a benefit advisory. To ensure coverage eligibility, member can request prior authorization before entering treatment.

Contact the Provider Assistance Unit at 509-241-7206 or 1-888-767-4670 for questions about a member's health plan benefits.